Baylor College of Medicine
Children’s Foundation - Uganda

Global Health Security

Directorate overview

The Global Health Security Program focuses on Improving Health Security and Building International Health Regulations core capacities in the Republic of Uganda. The Directorate aims to strengthen country-level capacity to prevent, detect and respond to public health threats of national and international concern.

 

Key targets in strategic plan: The Directorate contributes to Strategic Objective 2 in the strategic plan “Strengthen prevention, detection and response to public health threats/emergencies”

Structure of the directorate: The Director, Global Health Security Oversees the directorate with support from a Program Manager , M&E Manger and Project Coordinators

Ongoing projects

The CDC funded Global Health Security Project (2020-2024); a 5-year grant seeking to strengthen further, establish and sustain Uganda’s capacity to implement core GHSA priorities and comply with IHR (2005). Project strategic objectives are to:

  1. Improve the prevention of avoidable epidemics;
  2. Improve the ability to detect threats early;
  3. Strengthen the capacity to respond rapidly and effectively to public health threats of national and international concern

The project currently operates at the national level, in the Rwenzori (9 districts, one city) and Bunyoro (8 districts, 1 city) regions, and other regions as the need arises, especially for emergency response work.

The GIZ funded KCCA COVID-19 Project (2022-2023); a 1-year grant seeking to Strengthen linkages between COVID-19 testing, surveillance and Home-based care to support the containment of COVID-19 in Kampala. Project strategic objectives are to:

  1. Strengthen the capacity of KCCA surveillance systems for early detection of suspected cases at the division, parish, and village levels
  2. Strengthen COVID-19 laboratory data management, reporting, and use at Kampala city private and public health facilities
  3. Enhance community systems and engagement for COVID-19 prevention and control through Home-Based Care

The project currently operates in five divisions (Central, Nakawa, Makindye, Rubaga, and Kawempe).

Closed projects:

The WHO Funded COVID-19 Contact Tracing and Follow up Project (2021); a short-term grant that supported the Ministry of Health (MOH) to strengthen reporting, contact tracing and follow up in selected regions. Project strategic objectives were to:

  1. To strengthen contact identification, listing and follow-up for all COVID-19 confirmed cases.
  2. To improve data management and daily situation reports through GoData and ODK respectively

The project was implemented in across 63 districts in six health regions of Jinja, Masaka, Mbale, Moroto, Mubende and Soroti.

 

GHS Capacity Statement

Laboratory Systems Strengthening

Since 2007, Baylor-Uganda, with funding from CDC and USAID, has been supporting the Ministry of Health to build a laboratory network with the capacity to provide diagnostic and surveillance services. Baylor Uganda uses the Strengthening Laboratory Management Towards Accreditation (SLMTA) approach to train labs to implement the Laboratory Quality Management System (LQMS) and attain international accreditation status. Baylor-Uganda also supports Laboratory infrastructure and equipment procurement, Laboratory equipment management through subgrants to two regional laboratory equipment workshops, supply chain management, Biosafety and Biosecurity and a robust specimen referral and transportation system. The Laboratory capacity-building program is done through training, mentorships and quality assurance in collaboration with Uganda MOH’s National Health Laboratory System (UNHLS). Through this capacity, the laboratory network is able to deliver quality results to inform clinical decisions, early detection and response to disease outbreaks.

  • Public health laboratory leadership, coordination and communication:

    32 districts in Rwenzori, Bunyoro and Mbale region implementing district-specific laboratory network plans and district-led diagnostic network improvements.

  • LQMS:

    1394 Laboratory staff trained in LQMS; 15/21 lab hubs attained and sustained international/ISO 15189 accreditation by the South African National Accreditation System, one regional laboratory additionally accredited for microbiology diagnostics, and the Center of Excellence Laboratory (Kampala) attained and sustained the College of American Pathologists accreditation.

  • Laboratory infrastructure improvements:

    Upgraded/refurbished 25 laboratories in 21 districts to optimize testing workflow and enhance biosafety and biosecurity

  • Capacity for the detection of priority diseases:

    Trained and mentored 2,231 Health care workers from 55 health facilities in 17 districts and 3 cities on COVID-19 RDT use, reporting using electronic laboratory investigation forms and supply chain management, and quality assurance; Rolled out point of care EID/Viral load and Xpert/MTB Rif testing in 32 health facilities in 21 districts.

  • Biosafety and Biosecurity:

    Trained and mentored 394 laboratory personnel in biosafety and biosecurity, creating a pool of personnel to support the implementation of comprehensive and sustainable biosafety and biosecurity procedures and practices at the health facility level

  • Laboratory Supply Chain Management:

    Trained and mentored 428 laboratory personnel in logistics management to support the purchasing and management of diagnostic commodities; Provided buffer microbiology laboratory reagents for two regional laboratories as a stop-gap measure

  • Specimen referral and transport system:

    Established mechanisms to ensure transportation of specimens from over 300 health facilities (i.e. >90% of health facilities) are transported to 20 hub laboratories and two national reference laboratories.

ANTIMICROBIAL RESISTANCE (AMR) PREVENTION AND CONTROL

The emergence and spread of drug-resistant pathogens that have acquired resistance to existing antimicrobial agents is a threat to human health and modern medicine and is a risk to animal health and food production. Baylor-Uganda supports the Ministry of health to prevent and control the spread of AMR through strengthening AMR surveillance and ensuring the appropriate use of antimicrobials. This support is delivered through technical assistance provided to MOH in the AMR technical working groups, building the capacity of hospitals to conduct AMR surveillance and implement antibiotic stewardship activities.

  • AMR surveillance:

    • Conducted AMR diagnostic network capacity assessments at 12 hospitals and developed and implementation of site-specific QI plans.
    • Two regional labs conducting bacterial culture and susceptibility testing.
    • Provided buffer Microbiology/AMR reagents to avert stockout and critical equipment (incubators).
    • Standardized AMR detection and reporting procedures and practices by adapting and disseminating technical AMR laboratory SOPs and tools at two regional referral hospitals labs (Hub) and 10 general hospitals (spokes)

  • Promoting optimal use of antibiotics:

    Established Medicines and Therapeutics Committees (MTCs) and developed site-specific QCI plans at 10 hospitals. Operationalized QCI learning collaborative between the 10 hospitals to promote sharing of Knowledge and best practice sharing.

FIELD EPIDEMIOLOGY TRAINING PROGRAM (FETP)

Since 2020, Baylor-Uganda has served as an attachment site and provides mentors for the National FETP fellows. The national FETP was formed in 2015 as a partnership between the Ministry of Health, CDC and Makerere University School of Public Health. The FETP trains fellows to identify and contain outbreaks before they become epidemics and strengthen their skills in data collection and translation of data into evidence-based action. Baylor-Uganda programs including the HIV/AIDS, RMCAH and GHS programs together with the experienced mentors provide excellent attachment experience for fellowships. Since 2020, we have hosted and mentored 8 fellows and done 8 projects.
  1. Investigation of possible preventable causes of COVID-19 deaths in the Kampala Metropolitan Area, Uganda, 2020–2021. https://www.sciencedirect.com/science/article/pii/S120197122200296X
  2. Community Dialogue Meetings among District Leaders Improved Their Willingness to Receive COVID-19 Vaccines in Western Uganda, May 2021. https://uniph.go.ug/district-leader-community-dialogue-meetings-improved-willingness-to-receive-covid-19-vaccines-in-western-uganda-may-2021-a-pre-post-study/
  3. High blood pressure and associated factors among HIV-infected persons aged 13 to 25 years selected health facilities in Rwenzori region, western Uganda, September–October 2021.
  4. Birth outcomes among HIV-positive women in Rwenzori region, Western Uganda, 2021.
  5. Individual and household risk factors for COVID-19 infection among household members of COVID-19 patients in Home based care in Western Uganda, 2020.
  6. Factors associated with retention in care among HIV-exposed infants in Rwenzori region, Western Uganda.
  7. Cascade of NCD care in HIV clinics in Western-Uganda
  8. Effects of COVID-19 on ART services utilisation among people living with HIV and AIDS in the Rwenzori Region, Mid-Western Uganda, 2020-2021

COVID-19 VACCINE TRIALS

Baylor-Uganda is implementing two clinical trials to test the efficacy of COVID-19 vaccines:

CoVPN 3008 (Ubuntu): Multi-Center, Randomized, Efficacy Study of COVID-19 mRNA Vaccine in Regions with SARS-CoV-2 Variants of Concern:

The study is designed to help inform which vaccine regimen, likely in combination with enhanced HIV care, could serve as a public health model for an effective and cost-efficient approach to preventing SARS-CoV-2 disease, prolonged viral shedding, and the emergence of VOCs within this population. The study will also evaluate whether immune responses postvaccination can be correlated to these clinically important outcomes. The study will enroll 15,600 adults from many clinics in Eastern and Southern Africa. All participants in the study will get the study vaccine.

VAT 00008(COVPN 3005): A parallel-group, Phase III, multi-stage, modified double-blind, multi-armed study to assess the efficacy, safety, and immunogenicity of two SARS-CoV-2 Adjuvanted Recombinant Protein Vaccines (monovalent and bivalent) for prevention against COVID-19 in adults 18 years of age and older

 

COVID-19 Immunization

The Ministry of Health (MoH) started to roll out COVID-19 vaccination in May 2021. Since then, Baylor-Uganda has supported the Ministry of Health (MoH) through the Uganda National Expanded Program on Immunization (UNEPI) to implement routine/targeted COVID-19 vaccination and Accelerated Mass Vaccination Campaigns (AMVC) at the national and subnational level (17 districts and two cities in Bunyoro and Rwenzori regions). Our support includes capacity building for healthcare workers (HCWs) and community mobilizers, microplanning and coordination, supportive supervision and mentorship, vaccine supply chain management, data management, Advocacy, risk communication and community engagement. As of August 2022, 88% (2,625,739) and 61% (1,816,732) of the target population people from Rwenzori and Hoima regions had received the first dose and were fully vaccinated for COVID-19 respectively.

  • Micro-planning:

    Supported 17 districts and two cities in Bunyoro and Rwenzori regions to develop, implement and monitor COVID-19 vaccination micro-plans for 3 AMVCs; supported coordination of the campaigns

  • Capacity building:

    Trained 7296 vaccinators (HCWs) and 18573 mobilizers in Bunyoro and Rwenzori

  • Advocacy, Risk Communication and Community Engagement:

    Supported the MoH to develop communication messages and materials; printed and distributed over 700, 000 COVID-19 IEC materials; Engaged over 200 political, religious and cultural leaders to advocate for COVID-19 vaccination; Conducted x radio shows and aired x spot messages.

  • Supply Chain Management:

    We supported stock reporting and monitoring, and last-mile delivery vaccines including re-distribution to ensure sufficient stocks and avert vaccine expiries. 1,105,743 COVID-19 vaccine doses were delivered to healthcare facilities. Improved COVID-19 vaccination reporting from 17.5% to 95% in 3 months.

  • Service delivery:

    Supported COVID-19 vaccination at 383 static sites, 99 community outreach vaccination sites, and 1525 AMVC sites

  • Data management:

    Supported COVID-19 backlog data entry and reduced backlog from x % to x% in 3 months, and roll out of SMART paper technology for real vaccine data capture in 17 districts and 2 cities.

  • Monitoring of adverse events following immunization (AEFI):

    Established pharmacovigilance sub-committees in 10 hospitals supporting, supporting the detection, reporting and follow-up of AEFI.

     

Surveillance

Baylor Uganda works in collaboration with the Ministry of Health and other partners to strengthen surveillance systems that are able to detect events of public health significance early to facilitate a timely response. We support surveillance by providing both financial and technical resources for the development and review of national guidelines, support both national and subnational training in surveillance, and second technical staff to both the National Emergency Operation Centre (EOC) and the Department of Integrated Epidemiology, Surveillance and Public Health Emergencies (IES&PHEs) of Ministry of Health. This support is aligned to the IHR core capacity requirements for surveillance including; ensuring a functional surveillance system to identify potential events of concern for public health and health security is in place; the surveillance system is supported by electronic tools, and supporting systematic analysis of surveillance data for action.

  1. Strengthening surveillance systems to identify potential events of concern for public health and health security:

Since 2020, we have provided technical assistance to the MoH in strengthening surveillance systems. We supported the development of the national integrated epidemiology surveillance and response strategic plan 2021-2025, adaptation and rollout of the 3rd edition Integrated Disease Surveillance and Response strategy (IDSR), a framework for implementation of indicator and event-based surveillance. Some of the achievements are

  • Supported 3rd edition IDSR adaptation and development of the Integrated Epidemiology, Surveillance and Response Strategic plan 2021 – 2025
  • Provided technical support in IDSR rollout of in 48/148 districts in 6 Regions (Karamoja, Lango, North Central, West Nile, Rwenzori and Bunyoro) of the country
  • Provided direct support to IDSR rollout in 17 districts and 2 cities in Rwenzori and Bunyoro Regions where 100 IDSR district-based mentors/trainers; 184 health facilities and 600 health workers have been trained.
  • Provided TA to MoH in development protocols for Acute Febrile Illnesses (AFI) and Severe Acute Respiratory Illness (SARI) Influenza Like Illness (ILI) surveillance including COVID-19 genomic sequencing and Pan Respiratory Disease Surveillance (PRDS). AFI implementation has begun in Jinja Regional Referral Hospital, while SARI/ILI/COVID19/PRDS protocol is currently under review and approval

Together with other stakeholders we are providing technical assistance to MoH in strengthening one health event-based surveillance (EBS). The following are some of the achievements

  • Developed of one health event-based surveillance technical documents (one health priority list, signal list, EBS manual and M&E plan), these are currently under approval by MoH
  • Developed of one-health EBS training curriculum for national, district, sub-county, facility and community level, under approval by MoH
  • Supported national one health EBS ToT, where 56 national trainers were trained
  • Spearheaded development and piloting Regional EOC led one health EBS implementation in Kabarole District and Fort portal City in Rwenzori Region, where;
    • 22 district based one-health trainers/mentors have been trained in Fort Portal and Kabarole
    • 138 sub-county one-health EBS supervisors were trained in Fort Portal and Kabarole
    • Surveillance focal persons and Incharges from 26 facilities in Fort Port Portal and 36 in Kabarole were trained in Fort Portal and Kabarole.
    • 800 VHTs in Fort Portal and Kabarole were trained
  1. Strengthening application of electronic tools in surveillance system

Baylor Uganda is supporting MoH in implementation of electronic tools in surveillance.

  • At the national level consultants seconded to the Division of Health Information, MoH have provide Technical Assistance in the development of a centralised surveillance data warehouse, which will increase access to available data for analysis, visualisation and use to inform epidemic intelligence
  • Provided capacity building in implementation electronic tools for surveillance including DHIS2, electronic laboratory information system, electronic IDSR and GoData.
  • Supported MoH in development of an event management system

 

  1. Supporting systematic analysis of surveillance data for action

Baylor Uganda champions the routine analysis and utilization of data for action including monitoring, evaluating, and improving policies, programs, and services and facilitating the better allocation of resources.

  • At the national level, the epidemiologists seconded to the IES&PHEs produce weekly epidemiological reports; the National EOC also produces dashboards and disseminates situation reports of events and ongoing outbreaks
  • The national and regional EOCs produce analyses and disseminate epidemiologic interpretations of all major events at all levels.
  • Through the routine analysis of surveillance data at both national and regional levels, the epidemiologists were able to identify bottlenecks to both timeliness and completeness of reporting in Rwenzori, Bunyoro, and Kampala Capital City Authority. The implementation of targeted mentorships has since improved completeness in the three regions to the national target of 80%.

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